中国现代医学杂志2026，Vol.36Issue(2)：7-15,9.DOI:10.3969/j.issn.1005-8982.2026.02.002
艾司氯胺酮和右美托咪定作为超声引导下竖脊肌阻滞佐剂对胸腔镜肺手术术后镇痛的影响
Effects of esketamine and dexmedetomidine as adjuvants for ultrasound-guided erector spinae plane block on postoperative analgesia after thoracoscopic lung surgery
摘要
Abstract
Objective To compare the therapeutic effects of esketamine and dexmedetomidine as adjuvants to ropivacaine for erector spinae plane block(ESPB)in video-assisted thoracoscopic surgery(VATS).Methods A total of 105 patients who underwent ESPB during VATS at The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from June 2025 to August 2025 were enrolled.They were randomly divided into 3 groups:RC group with ultrasound-guided ESBP using 30 mL 0.375%ropivacaine,RD group with ultrasound-guided ESPB using 30 mL dexmedetomidine plus 0.375%ropivacaine,and RE group with ultrasound-guided ESPB using 30 mL esketamine plus 0.375%ropivacaine.All patients underwent ultrasound-guided ESPB at the T5 vertebral level before operation.The primary outcome was the duration of analgesia.Secondary outcomes included Visual Analogue Scale(VAS)scores at 1,6,12,24 and 48 h after operation,intraoperative consumption of sufentanil,remifentanil and propofol,intraoperative mean arterial pressure(MAP)and heart rate(HR),intraoperative consumption of metaraminol,intraoperative fluid intake and output,the number of patients requiring rescue analgesia and the number of patient-controlled analgesia(PCA)pump presses within 48 h postoperatively,chest tube indwelling time,postoperative length of hospital stay and incidence of postoperative adverse reactions.Results The duration of analgesia in the RD and RE groups was longer than that in the RC group(P<0.05),and the duration of analgesia in the RD group was longer than that in the RE group(P<0.05).The number of PCA pump presses within 48 hours postoperatively was lower in the RD and RE groups than in the RC group(P<0.05),and it was lower in the RD group than in the RE group(P<0.05).The time to onset of blood pressure reduction was shorter in the RD and RE groups than in the RC group(P<0.05),and it was shorter in the RD group than in the RE group(P<0.05).The total intraoperative fluid intake in the RD group was greater than that in the RC and RE groups(P<0.05),and the intraoperative consumption of metaraminol in the RD group was greater than that in the RC and RE groups(P<0.05).The intraoperative consumption of metaraminol in the RC group was greater than that in the RE group(P<0.05).Comparison of VAS scores at rest and during coughing at 1,6,12,24,and 48 hours postoperatively among the RC,RD,and RE groups showed that they were different across the time points(P<0.05)and among the groups(P<0.05),with the RD and RE groups having lower VAS scores,indicating relatively better analgesic effects.There were statistically significant differences in the change trends of VAS scores at rest and during coughing among the three groups(P<0.05).Comparison of MAP and HR upon entering the operating room,after nerve block,after anesthesia induction,after tracheal intubation,at the time of skin incision,at the time of skin closure,and at the end of surgery among the RC,RD,and RE groups showed that they were different across the time points(P<0.05)and among the groups(P<0.05),with the RE group having the highest MAP,followed by the RC group,and the RD group the lowest.There were statistically significant differences in the change trends of MAP and HR among the three groups(P<0.05).No statistically significant differences were observed among the RC,RD,and RE groups in terms of duration of surgery,consumption of sufentanil,consumption of remifentanil,consumption of propofol,total intraoperative fluid output,postoperative length of hospital stay,or the incidence of nausea and vomiting,dizziness,hypotension,or bradycardia(P>0.05).The chest tube indwelling time was shorter in the RD and RE groups than in the RC group(P<0.05).Conclusion Esketamine and dexmedetomidine as adjuvants to ropivacaine for ESPB in VATS can effectively prolong the duration of analgesia and reduce postoperative pain scores,but dexmedetomidine is superior to esketamine in the duration of analgesia.关键词
术后镇痛/艾司氯胺酮/右美托咪定/竖脊肌阻滞/电视胸腔镜手术Key words
postoperative analgesia/esketamine/dexmedetomidine/erector spinae plane block/video-assisted thoracoscopic surgery分类
医药卫生引用本文复制引用
朱晨,范薇,张嘉苡,徐忠能,李广明..艾司氯胺酮和右美托咪定作为超声引导下竖脊肌阻滞佐剂对胸腔镜肺手术术后镇痛的影响[J].中国现代医学杂志,2026,36(2):7-15,9.基金项目
江苏省卫生健康委员会科研项目(No:Z2023011) （No:Z2023011）
